Scapholunate Interosseus Ligament Research Articles

Reconstruction of an Early-Stage Scapholunate Advanced Collapse Wrist with the 3-Ligament Tenodesis Procedure: A Controversial Reappraisal.

The authors hypothesized that the 3-ligament tenodesis (3-LT) procedure is still sufficient-even in scapholunate advanced collapse (SLAC) cases-to reduce pain and improve wrist function. The authors compared patient-reported outcomes of scapholunate interosseus ligament (SLIL) injury patients with SLAC, to SLIL injury patients treated with 3-LT, and then to patients who underwent proximal row carpectomy (PRC), as a control group. The authors included all patients with a traumatic SLIL injury and associated SLAC components treated with 3-LT and completed patient-rated wrist evaluation (PRWE) questionnaires preoperatively and at 12-month follow-up. First, the authors compared matched patients with SLIL injury and SLIL injury with SLAC, stage 1 to 3, who received 3-LT. Second, the authors compared patients who received 3-LT with patients who underwent PRC, while having SLAC stage 2 or 3. The authors compared 51 patients with SLAC to 95 patients with SLIL injury who had a 3-LT procedure, and 10 3-LT patients were compared with 18 patients undergoing PRC, given SLAC stage 2 or 3. In both analyses, the PRWE scores had significantly improved in all groups; however, no significant differences in PRWE were found between 3-LT in SLIL injury and SLIL injury with SLAC (6.9 points; 95% CI, -14.92 to 1.22; P = 0.096) and between 3-LT and PRC, given SLAC stage 2 or 3, 15.1 points (not enough power). There is no difference in PRWE between matched SLIL injury patients with or without degenerative changes treated with a 3-LT. Therefore, the 3-LT procedure seems to be a viable treatment option for patients with early-stage SLAC wrist. Therapeutic, III.

MDCT arthrography assessment of the severity of cartilage damage and scapholunate dissociation regarding specific-component tears of the scapholunate interosseous ligament

Purpose: Untreated post-traumatic scapholunate interosseus ligament (SLIL) injury may lead to the development of a specific pattern of progressive wrist osteoarthritis known as SLAC (scapholunate advanced collapse), one of the most frequent patterns of wrist osteoarthritis. The dorsal component of SLIL is known to be the strongest and main responsible for scapholunate stability, as demonstrated in previous cadaveric studies. No previous study has evaluated the distribution and severity of cartilage damage and scapholunate dissociation considering component-specific tears of the SLIL, using an imaging technique where we can directly assess both cartilage and SLIL morphology.

Radiographic Stress Views in Radial Deviation of the Wrist after Sectioning of Scapholunate Ligament: A Cadaveric Study

Dear Sir, An increased scapholunate (SL) angle is one of the diagnostic parameters for evaluating scapholunate interosseus ligament (SLL) lesions. Usually this angle does not appear abnormally raised immediately after the actual injury as this needs the concurrence of several and persistent forces from the moment of the lesion onwards, basically axial loading of scaphoid, to accentuate the abnormal kinematics of the SL joint. A cadaveric study is presented to demonstrate that the torque forces transmitted through the SLL during forced radial deviation are abolished when this ligament is severed, leading to an increased SL angle. This may facilitate the diagnosis of SLL rupture during early stages of the injury by means of a simple radiographic lateral stress view in radial deviation.. One fresh frozen cadaveric specimen was used to carry out the study. Radiographic parameters measured were SL angle in neutral deviation with an intact SL ligament and then several stress lateral views of the wrist in radial deviation in the following three situations: SLL intact, division of the volar component of the SLL and simultaneous division of the proximal and dorsal components of the SLL. Radial deviation of the wrist was carried out manually and forced until an end point was felt. At this stage a radiograph was taken. During the manoeuvre of radial deviation, axial pressure was also applied to maintain the particular congruency at midcarpal and radio carpal levels. Measurement of the SL angles were made from digitalized pictures on computer screen using the tangential method. To carry out this study, initially the SL angle was measured in neutral deviation and it was found to be 53° Then, radiographic stress views of SL angle in radial deviation were also taken and the values did not change with an intact SLL or with a division of its volar component (Fig. 1) These SL angles still measured 53°. However, when proximal and dorsal components of the ligament were severed the SL angle increased to 70° during forced radial deviation. (Figure 2) Fig. 1 SL angle in maximum radial deviation (53°). SL ligament intact Fig. 2 SL angle in maximum radial deviation (70°). Proximal and dorsal SL ligament divided At SL joint level, carpal kinematics can cause two types of strain on the SL ligament: linear strain and torsional strain. When the SLL is damaged, linear strain leads to increased SL gap and torsional strain leads to increased SL angle [1–4]. Torsional forces on the SLL are generated when the scaphoid is brought into flexion and takes the lunate with it. This can be achieved through axial compression of the scaphoid by the trapezium and trapezoid when the wrist is radially deviated . Linear strain on the SLL can be generated also by axial loading of the wrist. This will lead mainly to linear distraction of the fibres of the SLL and to an increased SL gap. Consequently, if the aim is to test the integrity of SLL by the measurement of the SL angle, flexion of the scaphoid through radial deviation is probably the most specific manoeuvre. Based on the findings of this study, when the SLL is intact or only its volar component is divided and the wrist deviated radially, the transmission of torque forces is still preserved through the proximal and dorsal parts of this ligament and the lunate follows the scaphoid into flexion (Fig. 1). However, when all three components of the SLL, volar, proximal and dorsal, are severed, the lunate is unable to follow the scaphoid into flexion because the torque forces have been disrupted, which raises the SL angle significantly because the scaphoid flexes independently (Fig. 2). Further in vivo research is needed to support this cadaveric study. This could be carried out by identifying the possible correlation between radiographic measurement of the scapholunate angle in the stress views presented in this article and arthroscopic or perioperative findings.

Temperature in and Around the Scapholunate Ligament During Radiofrequency Shrinkage: A Cadaver Study

To investigate whether applied radiofrequency energy (RFE) for shrinkage of the scapholunate interosseus ligament reaches temperatures required for ligament shrinkage while leaving adjacent structures unaffected. Standard wrist arthroscopy was performed on 7 pairs of cadaveric limbs with continuous saline irrigation and gravity-assisted outflow through an 18-gauge needle. We subjected 14 scapholunate ligaments to treatment with monopolar (n= 7) or bipolar (n= 7) RFE for ligament shrinkage. Temperature was recorded simultaneously inside the dorsal part of the scapholunate interosseus ligament at a depth of 0.9 ± 0.1 mm and at 6 other sites in and around the wrist because thermal shrinkage starts at 60°C to 65°C. We observed an increase in temperature corresponding to the time of energy application. The highest measured peak temperatures at the scapholunate ligament were 43°C (monopolar) and 32°C (bipolar). Mean temperatures at 30 seconds of application were 29°C ± 7°C (monopolar) and 28°C ± 3°C (bipolar). Temperatures sufficiently high to induce ligament shrinkage were not reached with either monopolar or bipolar RFE. We did not monitor temperature levels responsible for damage on adjacent cartilage or immediately adjacent capsular tissue in this setting. This study suggests that RFE for capsular shrinkage in the wrist is safe but ineffective.

Scapholunate interosseus ligament reconstruction on a cadaver: A technique.

Background:Acute rupture of the scapholunate interosseus ligament is a relatively frequent occurrence which can be repaired primarily by direct suturing. However, patients are often seen a few weeks after injury when most of the ligament fibers have degenerated. This poses a challenge because direct repair can be difficult and long term results have not been satisfying. In the present study, a technique is presented to address this problem and its possible advantages are discussed.Materials and Methods:A fresh frozen wrist cadaver specimen, thawed to room temperature, was used to carry out the procedure. The scapholunate joint was exposed through a dorsal approach and stabilized using two percutaneous Kirschner wires. Using a U shaped chisel, a groove along the scapholunate articular margin was created to accommodate a strip from the extensor retinaculum as a ligament plasty. This has been secured using six anchor sutures and several pictures taken during the procedure to expose the key steps.Results:The ligamentoplasty presented in this article preserves most of the articular surface of proximal carpus and at the same time stabilizes the scapholunate joint. However, more in vivo research should be carried out to validate this treatment.Conclusion:The technique suggests a possible way to repair a ruptured scapholunate interosseus ligament that cannot be repaired primarily. Because osteointegration of the ligament strips is not possible in the present experiment, biomechanics of the construct cannot be fully tested.

Dynamic CT technique for assessment of wrist joint instabilities

To develop a 4D [three-dimensional (3D) + time] CT technique to capture high spatial and temporal resolution images of wrist joint motion so that dynamic joint instabilities can be detected before the development of static joint instability and onset of osteoarthritis (OA). A cadaveric wrist was mounted onto a custom motion simulator and scanned with a dual source CT scanner during radial-ulnar deviation. A dynamic 4D CT technique was utilized to reconstruct images at 20 equidistant time points from one motion cycle. 3D images of carpal bones were generated using volume rendering techniques (VRT) at each of the 20 time points and then 4D movies were generated to depict the dynamic joint motion. The same cadaveric wrist was also scanned after cutting all portions of the scapholunate interosseus ligament to simulate scapholunate joint instability. Image quality were assessed on an ordinal scale (1-4, 4 being excellent) by three experienced orthopedic surgeons (specialized in hand surgery) by scoring 2D axial images. Dynamic instability was evaluated by the same surgeons by comparing the two 4D movies of joint motion. Finally, dose reduction was investigated using the cadaveric wrist by scanning at different dose levels to determine the lowest radiation dose that did not substantially alter diagnostic image quality. The mean image quality scores for dynamic and static CT images were 3.7 and 4.0, respectively. The carpal bones, distal radius and ulna, and joint spaces were clearly delineated in the 3D VRT images, without motion blurring or banding artifacts, at all time points during the motion cycle. Appropriate viewing angles could be interactively selected to view any articulating structure using different 3D processing techniques. The motion of each carpal bone and the relative motion among the carpal bones were easily observed in the 4D movies. Joint instability was correctly and easily detected in the scan performed after the ligament was cut by observing the relative motion between the scaphoid and lunate bones. Diagnostic capability was not sacrificed with a volume CT dose index (CTDI(vol)) as low as 18 mGy for the whole scan, with estimated skin dose of approximately 33 mGy, which is much lower than the threshold for transient skin erythema (2000 mGy). The proposed dynamic 4D CT imaging technique generated high spatial and high temporal resolution images without requiring periodic joint motion. Preliminary results from this cadaveric study demonstrate the feasibility of detecting joint instability using this technique.

Arthroscopic Repair of the Scapholunate Interosseous Ligament

Scapholunate injuries are the most frequent of the intercarpal ligament injuries in the wrist. Current repair methods generally involve an open approach the dorsal capsule of the wrist. Arthroscopic repair of the dorsal portion of the scapholunate interosseus ligament would carry the advantages of less stiffness and would preserve the important dorsal capsular stabilizers. In the development of this technique, we first sought to determine the anatomic location and accessibility of the dorsal scapholunate ligament and the site in which a suture anchor would be placed. Ten fresh-frozen cadaver limbs were used. With the arthroscope in the 4 to 5 portal, the most dorsal portion of the SLIL was visualized in each specimen. K-wires were inserted through the 3 to 4 portal into the scaphoid adjacent to most distal portion of the dSLIL visualized. All limbs were dissected and the location of the wires relative to the prominence on the scaphoid directly adjacent to the central portion of the dSLIL was measured. The location of the prominence relative to the dSLIL was studied through magnified photography of a stained section of a cadaveric scaphoid. The mean distance of these wires distal to the center of the dSLIL is presented. Then the technique of arthroscopic repair of the dSLIL was developed using additional cadaveric wrist specimens. The technique is described.

Treatment of acute scapholunate ligament injuries with bone anchor

Scapholunate instability is the most common form of carpal instability. Repair or reconstruction of the scapholunate interosseus ligament is advocated to reduce symptoms, stabilize the scapholunate joint and avoid the progression of carpal degeneration. Aim of this study is to evaluate the results (clinical and radiographic) obtained in 18 patients treated in our department for acute lesions SLIL from 2003 to 2008. Patients were 16 males and 2 females with an average age at the time of the trauma of 33.8 years old (min 17 and max 68 years). The diagnosis of scapholunate dissociation relies on a through history and physical examination and imaging studies. Early surgical repair of the torn schapolunate ligament was performed in all the patients. The method used for the treatment of these lesions was open reduction and direct ligament reinsertion through a minianchor MITEK. In our surgical experience in 3 cases we have found a combination between an isolated scaphoid fractures and a scapholunate ligament rupture without carpal dislocation. We reviewed all patients treated with an average follow-up of 32 months (range 9-68 months). The review was carried out both clinically and radiographically (static and dynamic). We achieved 13 excellent results (Mayo score average 94,77), 3 good results (Mayo score average 84), 1 sufficient results (Wrist score 72) and 1 bad result (Wrist score 35). From the radiographic evaluation we found a loss of reduction in the two cases identified clinically as sufficient and bad. One patient after an optimal ligament healing, underwent to a recurrence of the lesion SLIL 2 years from surgery. Open reduction and direct bony fixation of the torn scapholunate ligament using a suture anchor is generally successful in restoring scapholunate stability and has produced good functional mid-term results. At an average follow up of 32 months excellent or good functional outcomes were reported in 88% of the patients despite a large number of cases with a high energy trauma and other associated injury. The association between an isolated scaphoid fracture and a SLIL lesion is rare but not impossible in presence of a scapholunate instability we recommend the immediate reconstruction of the torn ligament.

Differential Strain of the Axially Loaded Scapholunate Interosseus Ligament

To directly measure strain changes in the scapholunate ligament via magnetic resonance imaging (MRI) when axially loading the wrist in the neutral and extended positions. Six asymptomatic male volunteers without known history of previous wrist injury were enrolled in this MRI-based study. Each subject underwent 3 MRI scans in a 3T scanner: in resting neutral position, in neutral with axial load applied, and in extension with axial load applied. Axial load was applied via extension of an elastic band with known force/elongation curve. We analyzed images and converted them to 3-dimensional stereolithographs. Attachment points of the palmar, proximal, and dorsal sections of the scapholunate interosseus ligament (SLIL) were identified. The lengths of the resulting vectors were recorded for each position. Strain, defined as change in length divided by original length, was calculated for the axially loaded neutral and extended wrists. We used the Bonferroni adjusted multiple comparisons from an analysis of variance model, with statistical significance defined as p < .05. Strains were significantly greater in the palmar (p = .02) and proximal (p = .01) subregions of the SLIL in loaded extension versus loaded neutral positions. In contrast, the strain on the dorsal component in extension was not statistically greater than in the neutral position (p = .45). Axial load in neutral resulted in minimal strain of all 3 components of the SLIL complex, and these were not significantly different from each other (p > .99). With extension, the strains of the palmar (p = .03) and proximal (p = .006) regions were statistically greater than that of the dorsal component. In extension, strain is greatest in the palmar and proximal portions of the intact SLIL. Axial load in neutral applies minimal strain to the SLIL complex. Avoiding axial loading in extension and encouraging loading in neutral position may allow for decreased injury and more effective healing of the scapholunate ligament.

Palmare Handgelenksarthroskopie zur Beurteilung karpaler Begleitläsionen bei der operativen Versorgung distaler intraartikulärer Radiusfrakturen

Fractures of the distal radius, which currently are treated with palmar locking plates, are often accompanied by carpal lesions. Tears of the scapholunate interosseus ligament (SL) can affect the outcome. Between January 2007 and May 2008, 28 patients with distal intraarticular fractures of the radius were included in a prospective study. Preoperative CT-arthrography was performed. SL tears were found in 11 patients, with 10 partial and one complete rupture observed. A tear of the triangular fibrocartilage complex (TFCC) was detected in 16 patients. Every patient was operated with a palmar locking plate through a palmar approach between the flexor carpi radialis tendon and the radial artery. Then, a palmar wrist arthroscopy using a palmar portal was performed. Eleven SL tears with 9 partial and two total ruptures were diagnosed by arthroscopy. Ten lesions were associated with a C1-fracture with a fracture line projected onto the scapholunate interval. The TFCC was appraisable by palmar wrist arthroscopy only in 4 patients. Three of the SL tears detected by CT-arthrography could not be confirmed by palmar wrist arthroscopy. One complete rupture and one partial lesion confirmed by palmar wrist arthroscopy were found by CT-arthrography to be intact. Palmar wrist arthroscopy affords certainty when assessing the SL ligament. In this study, an assessment of ulnocarpal structures was not possible. For assessment of the ulnocarpal structures, CT-arthrography was superior to palmar wrist arthroscopy. However, the latter is an alternative during emergency treatment or when CT-arthrography is not available.

The natural history of an untreated isolated scapholunate interosseus ligament injury

The natural history of an untreated isolated scapholunate interosseus ligament injury remains unclear, although it is commonly assumed that patients continue to suffer with pain, stiffness and weakness of the wrist and ultimately develop secondary osteoarthritis (SLAC wrist). In this study, we evaluated the clinical condition of 11 patients with an arthroscopically proven interosseus scapholunate ligament injury, but without any radiological signs of either DISI deformity or scapholunate gapping, who had declined further treatment at an average follow-up of 7 years. Whilst there was on going pain and functional limitation in all cases, there was no rapid progression to degenerative change (SLAC wrist).

The scapholunate allograft: A biomechanical feasibility study

The feasibility of a new method for reconstruction of the isolated scapholunate ligament tear with a scapholunate allograft was studied biomechanically using a fresh cadaver upper extremity model. Seven specimens were first tested intact for wrist range of motion, contact characteristics of the radiocarpal articulation, and relative motion of the scaphoid with respect to the lunate. Then a segment consisting of the radial third of the lunate, the adjoining scapholunate interosseus ligament, and the proximal pole of the scaphoid was resected. This segment was matched to a donor allograft of similar size and geometry, which was then placed into the recipient carpus and secured with one central transverse Kirschner wire and two shorter interfragmentary Kirschner wires placed into the lunate and scaphoid. The allografted specimen was subjected to the same tests as the intact wrist. Results showed that there were no significant differences in wrist range of motion, radiocarpal articular surface contact area and pressure, and relative flexion-extension rotation between the scaphoid and lunate during passive radioulnar deviation between the intact and allografted wrists.

Carpal instability

The Journal of Bone and Joint Surgery. British volumeVol. 76-B, No. 5 ArticlesFree AccessCarpal instabilityJK Stanley, IA TrailJK StanleySearch for more papers by this author, IA TrailSearch for more papers by this authorPublished Online:1 Sep 1994https://doi.org/10.1302/0301-620X.76B5.8083254AboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited ByResults of Arthroscopically Assisted Volar and Dorsal Scapholunate Ligament Reconstruction Using Flexor Carpi Radialis: Modified Arthroscopic Corella TechniqueArchives of Hand and Microsurgery, Vol. 25, No. 2Radiographic assessment of the equine carpal joint under incremental loads and during flexionComparative Exercise Physiology, Vol. 15, No. 5Mediokarpale Instabilitäten der Handwurzel13 March 2018 | Der Unfallchirurg, Vol. 121, No. 5Rieducazione del polso traumaticoEMC - Medicina Riabilitativa, Vol. 23, No. 3Rehabilitación de la muñeca lesionadaEMC - Kinesiterapia - Medicina Física, Vol. 37, No. 2Ligamentäre Verletzungen der Handwurzel18 March 2015 | Trauma und Berufskrankheit, Vol. 17, No. S2Arthroscopically Diagnosed Scapholunate Ligament Injuries Associated With Distal Radial Fractures: A 13- to 15-Year Follow-UpThe Journal of Hand Surgery, Vol. 40, No. 6Carpal Instabilities in Athletes10 June 2015Spectrum of Carpal Dislocations and Fracture-Dislocations: Imaging and ManagementAmerican Journal of Roentgenology, Vol. 203, No. 3Scapholunate and Lunotriquetral InjuriesSports Medicine and Arthroscopy Review, Vol. 22, No. 1Carpal Instabilities in Athletes17 January 2015Carpal Instability in Athletes22 June 2011Begleitverletzungen distaler Radiusfrakturen16 September 2010 | Der Unfallchirurg, Vol. 113, No. 10Radiographic Evaluation of the Modified Brunelli Technique Versus the Blatt Capsulodesis for Scapholunate Dissociation in a Cadaver ModelThe Journal of Hand Surgery, Vol. 35, No. 10Ligamentäre Verletzungen der Handwurzel und deren Folgen8 July 2010 | Trauma und Berufskrankheit, Vol. 12, No. S3Addendum: ‘Dorsal Intercalated Segment Instability’ (disi-instabiliteit)Fractures and Dislocations of the CarpusThree-Ligament Tenodesis for the Treatment of Scapholunate Dissociation: Indications and Surgical TechniqueThe Journal of Hand Surgery, Vol. 31, No. 15a Addendum: ‘Dorsal Intercalated Segment Instability’ (DISI-instabiliteit)Arthrodesis for chronic static scapholunate dissociation: a prospective study in 12 patients8 July 2009 | Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, Vol. 38, No. 3Okkulte skapholunäre Dissoziation bei distaler RadiusfrakturWiener Klinische Wochenschrift, Vol. 115, No. 15-16The use of medical imaging-based kinematic analysis in the evaluation of wrist function and outcomeHand Clinics, Vol. 19, No. 3The Natural History of an Untreated Isolated Scapholunate Interosseus Ligament Injury29 August 2016 | Journal of Hand Surgery, Vol. 28, No. 4Sonography of the normal scapholunate ligament and scapholunate joint space1 January 2001 | Journal of Clinical Ultrasound, Vol. 29, No. 4Wrist Arthroscopy and Carpal InstabilityArthroskopie HandgelenkTransducer user syndrome: an occupational hazard of the ultrasonographerEuropean Journal of Ultrasound, Vol. 10, No. 1THE ROLE OF ARTHROSCOPY IN THE TREATMENT OF LUNOTRIQUETRAL LIGAMENT INJURIESHand Clinics, Vol. 15, No. 3Dorsal intercarpal ligament capsulodesis for scapholunate dissociation: Biomechanical analysis in a cadaver modelThe Journal of Hand Surgery, Vol. 24, No. 2The Clinical Importance of Carpal Instabilities Following Distal Radial Fractures29 August 2016 | Journal of Hand Surgery, Vol. 23, No. 4Carpal InstabilityThe Journal of Bone & Joint Surgery, Vol. 77, No. 3Signs of acute carpal instability associated with distal radial fractureEmergency Radiology, Vol. 2, No. 2 Vol. 76-B, No. 5 Metrics Downloaded 180 times History Published online 1 September 1994 Published in print 1 September 1994 InformationCopyright © 1994, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download